Handling the Medical Claim: An 8-Step Guide on "How To" Correct and Resolve Claim Issues

When a doctor sees a patient, how does the doctor’s office get paid? If a claim for a service or procedure provided is denied, how does the doctor’s office get the patient’s insurance company to pay? Handling the Medical Claim: An 8-Step Guide on "How To" Correct and Resolve Claim Issues explains—from beginning to end—how to bill and collect on claims for services provided in a physician’s office. Focusing on the CMS-1500 claim form, the book explains how to prepare and file the form to submit charges to patients’ insurance companies.


Written by a medical billing specialist experienced in handling medical claims and denials on both the provider and insurer sides of the business, this step-by-step guide begins by covering some basic good practice management skills. Next, it outlines each department’s specific duties based on the each department’s responsibilities for specific parts of the claim. In addition to learning how to submit and resolve claims that cannot be processed or are denied, readers will learn how to:


Enter data in the doctor’s schedule, including appointment types
Gather patient data from medical records
Register patients, including patient information, guarantor, and policyholder and insurance information
Input information about the appointment and diagnosis
Use the different types of coding systems used for billing charges
Understand the claim cycle, determine reimbursement, and apply payment
Obtain patient and insurance information
Appeal a denied claim and handle patient balances


The book includes case examples and step-by-step guidance for resolving claim issues that could arise—including how to determine what part of the chapter you can find your answer and how to link your findings to the box number on the claim form to which the problem pertains. Highlighting opportunities for increasing revenue, it includes an overview of the revenue cycle and the importance of keeping cash flow moving. Packed with forms, charts, and illustrative examples, the text supplies the tools and understanding you’ll need to manage billing and collection in any physician’s office or clinical department.